Chronic diseases, such as heart disease, type 2 diabetes, and cancer, account for seven of the top ten leading causes of death in the United States ¹ and people with chronic disease account for 84% of health care costs.² With approximately 150 million working adults,³ worksite wellness efforts to prevent chronic disease have the potential to reach a large portion of the American public. Comprehensive worksite wellness programs include both individual and employer level components to address physical and mental health and feature programs for employees to improve health behaviors such as nutrition counseling, organizational policies such as smoke free policies, benefits such as health insurance coverage, and workplace environmental supports such the provision of healthy food options in cafeterias.⁴ Worksite wellness programs have also been shown to be effective at changing health behaviors among employees, reducing employee absenteeism, and reducing healthcare costs.⁵ Previous research suggests the American workforce does not have good health behaviors. For example, in 2010, nearly three in ten employed adults in the United States had obesity and employed adults with obesity reported lower consumption of fruits and vegetables and less frequent leisure time physical activity than normal weight adults ⁶. Because obesity and low dietary quality are important risk factors for chronic diseases,^7,8 improving the nutritional quality of foods consumed at work can be a key component in worksite wellness efforts. This can include improving the healthfulness of foods offered in cafeterias and vending machines as well as foods served during meetings and events.⁹ These efforts have the potential to be far-reaching because around half of working adults have food or beverage vending machines at work and 30% have a cafeteria.¹⁰ Furthermore, over half of employed Americans report that cafeterias and vending machines were important sources of lunch purchases during work.¹¹

Despite the recognized effectiveness of worksite nutrition and physical activity interventions to prevent obesity,¹² little is known about recent worksite food behaviors or the foods that are obtained at workplaces. One recent study found employees reported that, although they may have access to cafeterias and vending machines at work, healthy options were limited.¹⁰ Most other studies of the healthfulness of foods in cafeterias were limited to the school environment,¹³ which is governed by United States Department of Agriculture (USDA) nutrition standards for school meals and not easily comparable to workplace cafeterias that service adults.¹⁴ Furthermore, existing studies of workplace nutrition are limited to interventions in small or non-representative workplaces.^15,16 Knowledge of how often foods are obtained at worksites, the people who obtain them, and nutritional information on the foods that are obtained could help guide efforts to improve nutritional intake of employees at work. Therefore, the purposes of this study are to examine how frequently employed U.S. adults obtain foods (including beverages) at work, determine how much they spend on these foods, identify the most common foods obtained, and measure the dietary quality of these foods.

During the seven-day study period, 23.4% of working adults had at least one free or purchased food acquisition from work with 16.8% having at least one free acquisition and 9.2% having at least one purchased acquisition (Table 1). Educational level was significantly associated with the prevalence of obtaining workplace foods overall and for free foods with prevalence highest among college graduates. Compared with men, women were significantly more likely to have free work food acquisitions (19.4% among women vs. 14.5% among men). Overall (free or purchased) food acquisition prevalence and free food acquisition prevalence also differed by race/ethnicity with highest prevalence seen among NH white and NH other persons.

Among the study population of working adults, 7.8% obtained foods at work on only one occasion during the study week, 4.5% obtained them on 2 occasions, 11.0% obtained them ≥3 times during the week and 5.4% obtained them ≥5 times (figure 1). For 99.8% of occasions where foods were obtained at work, the person reporting the occasion consumed the obtained food (data not shown). Snack/drink (48.0%) and lunch (28.9%) were the most common meal occasions cited for free or purchased work food acquisitions followed by breakfast (16.7%) and dinner (6.4%) (data not shown). Among those who purchased foods at work, the mean per capita amount spent on foods at work during the week was $7.52 (95% CI: 7.01–8.03; median: $4.38) and the mean amount spent per purchase occasion was $3.12 (95% CI: 2.50–3.75; median: $2.81) (data not shown).

The 10 most commonly obtained foods were coffee, regular soft drinks, sandwiches, tap water, tea, diet soft drinks, cookies/brownies, lettuce salad, French fries, and potato chips (Table 2). These 10 foods accounted for 44% of the foods obtained at work. Additional foods also included among the most commonly purchased foods were tortilla and other chips, candy containing chocolate, and crackers. The most common foods acquired for free also included chicken.

Among those who obtained foods at work, the overall per capita caloric value of all foods from work was 1292 kcal per week (Table 3) and 430 kcal per acquisition event (data not shown). Per capita caloric content of purchased foods (1080 kcal per week [95% CI: 861–1300]) and free foods (1206 kcal per week [95%CI: 1039–1373]) were similar among consumers of each food type. However, due to the greater frequency of free food acquisitions, free foods accounted for 68.5% of all calories obtained from work (data not shown). The leading 10 food category sources of calories obtained from work were pizza, sandwiches, regular soft drinks, cookies/brownies, burgers, egg/breakfast sandwiches, doughnuts/pastries, burritos/tacos, chicken, and potato chips (Table 3). These food categories collectively accounted for approximately half (52%) of all calories obtained at work. Leading food sources of calories were generally similar for purchased and free foods, although pizza was a larger source of free food calories compared to paid food calories and regular soft drinks were a larger source of paid food calories compared to free food calories.

Overall HEI-2010 score for foods obtained at work was 48.2 out of a maximum score of 100 (Table 4). HEI component scores that reflected lowest adherence to dietary guidelines were Whole Grains (2.6 out of a maximum of 10), Refined Grains (3.2 out of 10), Sodium (3.5 out of 10), Total Fruit (1.8 out of 5), Empty Calories (7.4 out of 20), Seafood and Plant Proteins (2.4 out of 5), and Whole Fruit (2.5 out of 5). Components that reflected greater conformance to dietary guidelines were Total Protein Foods (5.0 out of 5), Fatty Acids (7.7 out of 10), Total Vegetables (3.5 out of 5), Greens and Beans (3.4 out of 5), and Dairy (5.2 out of 10).

This study found that nearly a quarter of working adults in the study population obtained foods at work during a one-week period and that, on average the foods they obtained totaled 1292 kcal per week. HEI-2010 scores also suggest that the foods obtained at work are high in empty calories, sodium, and refined grains and low in whole grains and fruit. This is reflected in the leading food types obtained at work, which include many calorically dense foods that are typically high in solid fat, added sugars, or sodium such as pizza, regular soft drinks, cookies/brownies, cakes and pies, and candy. Similarly, the existing food away from home (FAFH) literature finds that FAFH tend to be higher in empty calories, sodium, and added sugars, but lower in fruits, vegetables, and whole grains.^22,23 While not as important a source of calories as foods from home and restaurants,²² foods obtained from work may represent an important contribution to caloric intake at worksites among those who obtain them frequently. For example, the results suggest that approximately 11% of working adults (16.5 million people) obtained foods at work at least three times per week and over 5% obtained them 5 or more times per week. Improving the nutritional quality of foods obtained at work could have a large impact on the overall diet quality among those employees who frequently obtain foods at work and worksites present an important opportunity to improve the nutritional quality of FAFH.

Results suggest that there are demographic differences in who obtains food from work. Educational level was by far the strongest predictor of obtaining food at work, with college graduates approximately 2 times more likely to obtain foods at work during the week than those without a high school diploma. Although data on occupation was not available, this difference may reflect the differing types of jobs and corresponding work places experienced by people with different educational attainment.²⁴ Previous research suggests that college- educated adults are more likely to work for large employers and that large employers are more likely to have places for employees to purchase food such as cafeterias and vending machines.¹⁰ Therefore, people with higher education may have greater opportunity to obtain foods at work. Furthermore, less dramatic differences were found according to sex and race/ethnicity, suggesting more women and fewer Black and Hispanic Americans obtained foods at work. Despite these differences, a nontrivial percentage of all demographic groups still obtained foods at work, suggesting that efforts to improve these foods could reach a wide swath of working Americans.

One of the most important findings was that foods obtained at work generally do not align with dietary guidance, with low HEI-2010 scores indicating lower dietary quality seen for several dietary components, particularly whole grains, refined grains, sodium, fruit, and empty calories. These results were generally similar to those found in an analysis of the nutritional quality of menu offerings in major fast food restaurant chains.²⁵ On the other hand, HEI scores suggest that foods obtained at work did provide vegetables, protein, and a relatively high ratio of unsaturated compared to saturated fatty acids. There is evidence that healthy dietary patterns, such as those that include adequate amounts of vegetables, fruits, and whole grains, may reduce the risk of many chronic diseases and certain types of cancers.⁸ In light of these findings, employers have many opportunities to improve the dietary quality of foods they sell or serve and in helping to improve the health of their workforce. Research suggests that many employees support such efforts. A recent study found that about half of employees supported accessible free water, affordable healthy food/drinks, and available healthy options at work.²⁶ One opportunity is the adoption of food service guidelines (FSG),²⁷ which provide minimum nutritional standards for foods sold or served and which also promote the selection of healthier food choices by employees. FSG provide an opportunity to systematically improve available food service venues from cafeterias and vending machines to meetings and events. Several science-based FSG have been developed, removing the need for employers to develop guidelines themselves.^27,28 As the study found that free foods are acquired more frequently than purchased foods and contribute nearly 70% of calories obtained at work, employers may also need to address the healthfulness of these foods. This may require different strategies than for purchased foods. For example, employers may consider improving the healthfulness of foods provided for free at meetings, in common areas, and during workplace social events.⁹ Given the high proportion of foods at work that are acquired for free, efforts to improve the dietary quality of foods provided by employers and coworkers free to employees represent a potentially far reaching and low cost means of improving the dietary intake of employees and promoting a workplace culture of health. In addition, employers can also utilize behavioral design strategies to reduce intake of less healthy snacks offered for free or purchase by placing them out of view or offering smaller serving sizes.²⁹ Shifting dietary patterns requires complementary strategies to improve food environments and diet; however, worksites where the average employee spends eight hours per week day can play a pivotal role in helping to normalize healthier dietary patterns. While foods from work represent a comparatively small share of calories consumed by Americans, the Institute of Medicine has recognized that encouraging active living and healthy eating at worksites is an important strategy as part of a multi-pronged approach to address the obesity epidemic.³⁰ Furthermore, comprehensive worksite wellness programs may also reduce absenteeism, improve worker productivity, and decrease costs associated with chronic diseases.³⁰

There are limitations to this study. First, information was unavailable on the type of work or industry in which study participants were employed, the shift they work, or the food amenities (cafeterias, etc.) available at their worksite. Such information would have been valuable for better understanding the results and targeting efforts to improve the worksite food environment. Nonetheless, this study was performed using a nationally representative sample making the results more generalizable to the US working population. Second, while the data showed that nearly all of the foods acquired at work were eaten by the person reporting the food acquisition, how much was eaten by that person was not known. Thus the calories of foods acquired may not reflect the amount and calories actually consumed. Third, there is also the possibility that the sources of foods were misclassified by study participants, particularly when the source could realistically be classified into more than one source type. For example, participants who work in schools, food service, or food retail may have classified their food acquisitions while working as coming from these other types of sources rather than from work. It is also possible that some foods acquired from outside restaurants or other sources during working hours were incorrectly classified as coming from work and that some foods obtained from vending machines at work were not specified as being obtained at work. Furthermore, the study had a relatively low response rate (41.5%) and was designed to be representative of US Households, not the population of US working adults. These factors may impact the generalizability of the study findings.

This study found that nearly a quarter of working adults in the study population obtained foods at work during a one-week period and the foods they obtained had limited dietary quality. Those obtaining foods at work obtained an average of 1292 kcal during the week and were more likely to be non-Hispanic white and have a college degree. There is a need to better align the foods obtained at work with dietary guidance and future research might address the effect of worksite food and nutrition interventions on the dietary quality of foods obtained from work.